Prospective study of hormonal and semen profiles in marathon runners.

OBJECTIVE: To investigate the effect of marathon training on hormonal and semen profiles in male athletes. DESIGN: Prospective longitudinal study over 1 year. SETTING: Department of Obstetrics and Gynaecology, University of Cape Town, South Africa. PARTICIPANTS: Twenty-four healthy male marathon runners, 25 to 54 years of age. MAIN OUTCOME MEASURES: Hormonal evaluation included determination of plasma concentrations of total T, LH, FSH, PRL, E2, and P. Semen analyses included an evaluation of count, motility, morphology, and volume. These profiles were correlated with training intensity. RESULTS: The intensity of training increased significantly in the first 5 months of the study. This was accompanied by a significant rise in serum PRL levels and a fall in P levels. No other significant hormonal changes were identified. The semen volume and sperm motility and morphology fell significantly during training, but there was no significant alteration in the sperm count. CONCLUSION: This longitudinal study demonstrates that endurance training can modify significantly hormonal profiles and semen parameters in long-distance runners.

Ultrastructural parameters of fertile cryopreserved human sperm.

Two hundred and forty-four cryopreserved semen samples were used for artificial insemination by donor (AID). All samples were examined for motility and concentration. Thirty of the samples resulted in pregnancies. These samples were further examined ultrastructurally. There was no difference in sperm motility or concentration between the samples that did or did not result in a pregnancy. The ultrastructural characteristics of the samples that resulted in pregnancies revealed that only 15% of sperm (SD = 7.67) possessed normal morphology and had undamaged acrosomes after cryopreservation.

The embryo freezing programme at Groote Schuur Hospital. First results.

'Surplus' embryos from 28 patients on the in vitro fertilisation programme at Groote Schuur Hospital were frozen for transfer in later cycles. Depending on the stage of the embryos, either propanediol or glycerol was used as a cryoprotectant. In 20 patients embryos survived the thawing procedure and were transferred. Five pregnancies resulted, 2 twin and 3 singleton. The pregnancy rate per embryo transfer in this group of patients in thus 25%. The pregnancy rate per freezing procedure is 19.2%.

Prevalence of Chlamydia trachomatis IgG and IgA antibody in gynaecology inpatients as determined by serum indirect immunoperoxidase assay.

Chlamydia trachomatis is common; at times the organism acts as a pathogen and can cause significant disease. Specific detection has always been difficult in a clinical setting and a variety of new tests have been developed for this purpose. The local prevalence of the infection is not well known nor are its significant associations. The serum of 98 patients in a gynaecology ward was assayed using an immuno-enzyme technique (indirect immunoperoxidase assay). Infection was detected in 59% of patients overall, compared with 87.5% of patients with pelvic inflammatory disease and 39.1% of pregnant patients. The statistical associations are discussed.

Mouse embryos cultured in amniotic fluid.

One thousand mouse embryos were collected over a period of 6 weeks and randomly assigned to either amniotic fluid aspirated during routine amniocentesis from normal 16 weeks pregnant patients or Earle's medium. The embryos were cultured for 72 hours at 37 degrees C in 5% carbon dioxide in air. Osmolarity, pH, partial arterial carbon dioxide pressure and HCO3- were checked before culture and again at the end of culture. Embryos were assessed according to the stage of development, namely degenerate embryos, morulae and blastocysts. The blastocysts were further divided according to their stage of development. There was a significant improvement in blastulation rate to fully expanded blastocysts in the embryos cultured in the amniotic fluid. The amniotic fluid was fairly variable in composition, pH and osmolarity, whereas the Earle's medium was very uniform in composition between trials. It was concluded that amniotic fluid drawn at 16 weeks from normal women is a good culture medium for mice embryos.

Infertility factors at the Groote Schuur Hospital Fertility Clinic.

Nine hundred and four patients who visited the Fertility Clinic at Groote Schuur Hospital during 1986 were classified according to infertility factors. In 36% of all couples a male factor was present, while 57% had a tubal, 29% an ovulatory, 7% a cervical immunological and 6% a uterine factor. Four per cent of all patients had endometriosis, and 2.4% had unexplained infertility. In 57% of cases only one factor was present, but in the rest between 2 and 5 factors contributed to the infertility of the couple. The study showed that in our population the most common infertility factors are in the male and in women with tubal problems, and resources should be channelled accordingly.

Pregnancy without ovarian function. A case report.

A 38-year-old nulliparous woman suffering from premature menopause was stimulated with oestradiol valerate in order to create an artificial endometrial cycle. Three oocytes were donated by a woman on an in vitro fertilisation cycle and were inseminated with the patient's husband's sperm. These were then transferred into the patient's uterus after the endometrium had been primed with progesterone to change it to the secretory phase. Pregnancy resulted and proceeded well. Gestation was terminated at the 34th week by caesarean section and 2 healthy boys and 1 girl were delivered.

An assessment of framelapse videography of the effect of cryopreservation on human sperm motility.

Sixteen sperm specimens collected from regular healthy donors at Groote Schuur Hospital Sperm Bank were assessed subjectively by phase contrast light microscopy and the results were compared with assessments made by framelapse videography. The same specimens were frozen and thawed and re-assessed by framelapse videography and the results compared with the pre-freeze assessments. The objective cryosurvival was found to be 53%. The subjective assessment varied by an average of 20% from the videographic method. Framelapse videography was found to be a practical reproducible method for assessment of sperm motility where accuracy is essential.

Changes in sperm motility, morphology and concentration induced by the swim-up procedure.

Fifteen semen samples from normal donors were washed twice in Earle's medium by centrifugation and allowed to swim up into overlayered Earle's medium. Aliquots of 0.2 ml were drawn before and after the swim-up, for assessment of sperm motility, morphology and concentration. The percentage of sperm showing progressive motility improved by an average of 54.02 +/- 45.97%, and sperm with the normal morphology increased by 63.8 +/- 31.01%. Head and tail abnormalities decreased by 47.17 +/- 21.3% and 89.37 +/- 16.1% respectively. There was no statistical change in acrosomal abnormalities. Sperm concentration was reduced by 89.02 +/- 7.4%. It is concluded that the standard swim-up technique resulted in an overall improvement in sperm quality, but that the technique was not effective in reducing the acrosomal abnormalities.

Influence of the swim-up procedure on acrosome damage induced by freezing human semen.

Twenty frozen semen samples from normal donors were thawed, washed in Earle's medium, and allowed to swim up using standard techniques. The samples were evaluated before and after the swim up for progressive motility and concentration. Morphologically normal sperm were assessed for acrosomal integrity according to the relative percentages of normal, damaged or lost acrosomes. The motility improved by 75.07 +/- 90.38%, the count was reduced by 97.1 +/- 1.9%, but there was no significant change in the frequencies of the different types of acrosome state. It was concluded that although the swim-up technique is successful in reducing most major morphological abnormalities, influence over the frequencies of secondary acrosomal abnormalities could not be demonstrated.

Ovulation induction for in vitro fertilisation using clomiphene citrate and low-dose human menopausal gonadotrophin.

Ovulation induction using a low dose of human menopausal gonadotrophins and clomiphene citrate for in vitro fertilisation and embryo transfer is described. Sixty-two cycles of ovulation induction were initiated in 37 patients. Forty-six laparoscopies were performed, yielding 116 oocytes. Of these, 90 (77.6%) cleaving embryos developed, and in 36 transfers 10 pregnancies (27.8%) were established. The use of low-dose hMG in conjunction with a programme on an outpatient basis may prove to be optimal for the purpose of in vitro fertilisation and embryo transfer.

Granulosa cell metabolism and the assessment of oocyte quality in IVF.

The progesterone production of the granulosa cells of the cumulus-oocyte complex correlates very well with the cleavage potential of embryos in an IVF system. The method is simple and can be easily performed by any laboratory associated with IVF. Furthermore, high intratubal progesterone levels in the immediate post-ovulatory period are probably important in prolonging the intra-ampullary residence of the oocyte or embryo until the uterine endometrium is optimal for implantation.

Routine hysteroscopy in infertility?

Fifty patients from the infertility Clinic at Groote Schuur Hospital who underwent laparoscopy as part of their work-up had a routine hysteroscopy at the same time, with the Hamou II hysteroscope. In all cases carbon dioxide was used as the distending medium. Only 4 patients had abnormalities detected by hysteroscopy. Three out of those 4 abnormalities could have been diagnosed by hysterosalpingography. Compared with hysteroscopy the diagnostic value of hysterosalpingography as a routine screening procedure was found to be adequate.

Hydatidiform mole after in-vitro fertilization: a case report.

A 25 year old patient was accepted on the in-vitro fertilization programme at Groote Schuur Hospital in Cape Town and her first IVF cycle resulted in a pregnancy. The patient did not return to the usual follow-up ultrasound until about 4 months after the embryo transfer when an ultrasound revealed the typical picture of a molar pregnancy which was confirmed by histology after evacuation.

Medroxyprogesterone acetate in non-metastatic gestational trophoblastic disease.

The effect of medroxyprogesterone acetate (MPA: Depo-Provera, Upjohn) as a contraceptive agent was assessed in 45 patients with non-metastatic gestational trophoblastic disease and compared with 13 patients using hormonal and 26 patients using non-hormonal methods of contraception. In the whole group of 84 patients 18 (21.4%) required chemotherapy. There was no statistically significant difference in the incidence of persistent trophoblastic disease between MPA (9/45) and the oral contraceptive group (2/13) and MPA and the non-hormonal contraceptive groups (7/26).

A simple method for cryopreservation of human sperm.

A simple method of cryopreservation of human sperm is discussed. Fifteen randomly collected samples were frozen and assessed after storage in liquid nitrogen. The mean recovery rate was 77% (range 62-91%) with no significant deterioration after 4 weeks' storage. The cryopreserved sperm is used in an artificial insemination by donor clinic and also sent to distant centres in the RSA and neighbouring countries. The method is also used for the cryopreservation of specimens of the sperm of patients undergoing vasectomy or radiotherapy, and in the Groote Schuur Hospital in vitro fertilization programme. Modification of the method will also allow human embryos to be frozen.

Rupture of the uterus in a primigravida. A case report.

After induction with oxytocin because of premature rupture of the membranes, a caesarean section had to be performed on a primigravid patient owing to fetal distress. At laparotomy a fundal rupture of the uterus was found. Rupture of the primigravid uterus in the absence of obstetric trauma or congenital abnormality is rare, and apparently only 4 cases have been reported. The condition does not appear to have been reported in the South African literature as yet.